Why NSAID's can cause trouble

June 14, 2005

Copied from a medical column: (And this answer is relating to non-

Bandsters - A Bandster's stomach and pouch are even more at risk)

SAndy R

Question: How detrimental to the stomach is taking ibuprofen 800 mg

two or three times a day over an extended period of time? What

symptoms signal potential stomach irritation or other disorders?

Answer: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) --

a class of very effective pain relievers that may cause serious

gastrointestinal side effects. The most common gastrointestinal

effects of these drugs are irritation and ulcers of the stomach and

upper intestine (duodenum). However, similar complications can

appear in any part of the gastrointestinal tract.

Both the benefits and drawbacks of NSAIDs stem from the fact that

they act on an enzyme, known as cyclooxygenase (COX), that is an

important mediator of inflammation. There are two types of COX: COX1

and COX2. Ibuprofen and most other NSAIDs block both types. COX2 is

found in areas of inflammation, so inhibiting this enzyme leads to

pain relief. COX1 is found in the gastrointestinal tract and serves

to maintain the normal lining of the stomach and intestine. Thus,

blocking COX1 can lead to ulcers.

After only three months of regular NSAID use, up to 20 percent of

people develop ulcers in the stomach and 10 percent develop ulcers

in the duodenum. Complicated ulcers (resulting in bleeding,

perforation or obstruction) occur in up to 4 percent of patients on

NSAIDs for one year. In contrast to ulcers caused by other factors,

NSAID-related ulcers are often " silent " : The patient experiences no

pain or other warning signs until after a serious complication

occurs. It's been theorized that this may be related to the pain-

relieving power of the NSAIDS themselves.

Obviously, it would be best for people to take painkillers that do

not injure the gastrointestinal tract. However, in many cases this

is not possible, and people must take medications to prevent ulcers

along with their NSAIDs. Such medications include proton-pump

inhibitors, such as omeprazole (Prilosec), and prostaglandin

analogues, such as misoprostel (Cytotec).

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